2. Digital Content for Frontline Health
Worker Training
Welcome and introductions (Carolyn)

3. About mPowering Who We Are
A partnership of private sector, government, donors, and program implementers
Our Mission
Help end preventable maternal and child deaths by accelerating the use of mobile technology to improve the performance of frontline health workers
How we are doing this
Increasing government led collaboration, and building capacity in-country to ensure high quality, sustainable, and scalable health education and training for Frontline Health Workers (FHWs)

4. Role of Frontline Health Workers
Deliver advice and services to patients in their homes and in clinics.
Counselors, educators and treatment providers.
Understand the beliefs, practices and norms of their communities.
Photo: Allan Gichigi, MCSP
Who better to address this source of poor health but FLHWs
They deliver advice and services to patients in their homes and in clinics, serving as counselors, educators and treatment providers. Because they often come from the communities they serve, they understand the beliefs, practices and norms of those communities, allowing them to provide more culturally appropriate health care.

5. Despite Their Importance support can be wanting…
How can mobile technology help?
Health workers overburdened with bulky textbooks, ill- suited job aids, etc.
Refresher trainings are inconvenient and inadequate when they actually take place
Few resources for on-demand training and information
Training materials costly to distribute and update
Multimedia content available in one place
Available for refresher trainings and constant reference
For example in Ethiopia HEWs:
13 Health Training courses are contained in 21 books (each approx pages), and all the content is in English (not the first language for any of the HEWs).
Access from many sources can be based on user’s workflow
Savings from reduction or elimination of print would pay for a digital content distribution program using smartphones

6. Why Distance Ed?
Multiple studies show, in aggregate, outcomes comparable between distance education and face-to-face but context is critical: For example: online Computer Science course at Georgia Tech $510 while comparable course on campus at USC $5,535 yet quality of education comparable Context in LMICs: refreshers not taking place, quality of face-to-face teaching methods vary greatly, and quite often basic training not always taking place

7. Why Video? Can compensate where literacy is an issue
mike
Can compensate where literacy is an issue
Video for understanding and retention
Not just about knowledge but behavior as well.

8. Why Government Ownership?
Ability to align with national curricula, context, and priorities
Consistency in training methodologies and durations
Prevent inequitable distribution of education and health services (SDG #3)
Photo: Karen Kasmauski/ MCSP
Uganda Case:
Mike
Although the Government of Uganda owns the VHT program, VHTs pay more allegiance to the IPs who provided them with more facilitation than government.
Poor IP coordination creates a problem for supervision of the program and eventually in sustainability when the partners’ projects end.
The report highlighted the inequity that arises from this fragmented approach, as it is often impossible to provide the same level of training for every worker in every district.
Implementing partners were not coordinated in offering their support to the VHTs. For example, they motivated VHTs differently, they had different reporting formats, and their program training followed different methodologies and durations.
Ministry report cited: inequitable access, lack of coordination between partners, FHW allegiance to partners rather than government, with different formats, methods and reporting formats impossible to standardize.

9. Why Government Ownership?
mike
Sample search using
‘Child Health’ at Google App Store

10. ORB Content Platform Carolyn, 15 min Introduction to ORB
Brief rationale for why ORB was created - training need, mHealth fragmentation, etc
Short ORB demo and overview of content
Show example of a video that is available on ORB
Show how to share content and benefits of sharing content
Creative Commons video? [Show if time allows]

11. What is ORB?
ORB is an online platform located at that contains freely available and downloadable training materials for frontline health workers.
Connect frontline health workers and those that support them to resources to expand their knowledge and skills
Allows content providers to share their materials

12. ORB Resources Mobile-ready Quality-assured Openly licensed
Use in mobile and blended training

13. Open Deliver Technology Process
A process-based solution designed for government
institutionalization, changing technology and shareable content
Monitor, Evaluate, Iterate
Address Demand
Identify & Adapt Content
Create Training
Program
Deploy Content
Deliver Training
Process
Mike
Open Deliver means Open Source Delivery of Digital Content
The stages of this process involve:
Identify the training needs of the health workers; take into account workflows and what devices the HWs use
Create or adapt existing multimedia materials for use for education (and/or community engagement – e.g. family planning counselling)
Access existing resources on a content sharing platform to save cost and prevent duplication (at this stage, additional materials could be added, such as quizzes and linking narrative between videos)
Deploy content to Android based tablets or devices
Collect usage analytics that track usage of media to determine what materials work and what do not
Open Deliver streamlines digital content delivery through the reconfiguration of existing technologies into a single, integrated, platform. This allows governments to assure the quality of all content used in the system. The process can accept multiple streams of content from different providers, and all providers are able to access the content sharing platform to ensure new content development is not duplicative. This can then be published to any Android device. The process is designed to be technologically independent – thus if an alternative technology exists that is better it can be rotated in to replace the existing technology used for that stage of the process without disrupting the entire process.
Content
Sharing
Library
Learning
Management
System
Client
Application
Technology

14. Identify & Adapt Content
Open Deliver
Address Demand
Identify & Adapt Content
Create Training
Program
Deploy Content
Deliver Training
Process
Monitor, Evaluate
Content
Sharing
Library
Learning
Management
System
Google Charts
Tableau
Excel
Client
Application
Technology
Joomla
Drupal
ORB
OPEN edX
Moodle
OPEN edX- Client
OppiaMobile
MoodleMobile
Products

15. User Centered Design Exercise
mike

16. Stage 1: Address Demand HEW Training in Ethiopia Midwives in Nigeria
ASHAs in India
Every country and context is different so the first stage involves a small representative sample of health workers you are targeting in a region.

17. Stage 2: Review/Create Content
Optional: Play Videos
Example: Scenario Based Video Training for Midwives

18. Stage 3: Store, Curate and Share
Content Providers (e.g. NGOs)
Global ORB
Validate and
Curate
National ORB
Access existing content at either the global level (ORB) or specific national level version
Share all created materials to prevent future duplication.
Business model based – in part – on reciprocity trading content for delivery

19. Stage 4: Deploy and Distribute
From learning management system to video instruction on mobiles
Access to Outernet

20. Stage 5: Evaluate and Iterate: mLearning
How does this work in practice?
Creating a training course:
Identified what skills and knowledge the health workers need
Then the training institution/government etc simply selects the most relevant content from ORB
Then additional resources can be created to link the set of videos (or other content) into a course. This could include adding linking text (e.g. “you are now going to watch a video on how to check the position of the baby. As you watch, notice how the midwife does x. y. z …..”), and multiple choice questions or other types of quizzes, to make a complete course suitable for the particular HW cadre.
Then, if necessary, content can be translated into relevant language(s)
New content can be added when needed
OKEY to talk about the specific example in Ondo State

21. Open Deliver in the Field
Ethiopia: (Oppia Mobile)
Ministry of Health approved health program (up to 30,000+ HEWs).
Nigeria: (iDEA)
Gates funded 300 midwives in 4 cities using system to improve counseling techniques
India: (Gyan Jyoti)
FP decision support tool for client education & engagement creating effective mCounseling tool
Pakistan: (Bright Future)
Undergoing pilot to adapt both mLearning and mCounseling functions for Lady Health Workers
to address entire RMNCH continuum
Nigeria /Ondo State: (VTR)
Working with State Health Mgmt Board Content extended to 100 facilities in 6 states & roll out to 550 PHCs in Ondo
This production system allows Governments working with individual programs to use the same platform to create and publish a wide range of content - whether for community engagement (mCounseling) or CHW training and education (mLearning). Each app can be customized in terms of appearance and language.
In Ondo state Nigerians are already running the platform
It took 14 days to produce a prototype in Urdu and English in the latest iteration of this process in Pakistan.

22. Demonstration Alex Little
mike

23. Achieving Government Ownership Through (MSC) Multi-Stakeholder Collaboration
Huguette and Mike, 10 min

24. Multi-Stakeholder Collaborative Goal
Develop a strategy for adapting proven technologies into a single, sustainable digital content delivery system that accepts validated multimedia content from any source.
Which leads to cost and efficiency benefits from optimization of resources

25. MSC: Assumptions and Principles
Acknowledge and overcome fragmentation/pilotitus
View data collection and content distribution as interdependent
Start with solutions that meet criteria (e.g. PDD)
Recognize/work within market trends
Sync with overall transition from hard copy to digital
Open library (strive for Creative Commons licensing)
Incentivize private sector investment
Technological solutions can drive policy
Acknowledge Fragmentation and move to consolidate fundamental functions under single Platform then allow new functions built on top
Treat Data Collection and Content Distribution as commodities which are “two sides of the same coin”
Work towards single platform that abides by Principles of Digital Development to ensure Sustainability(Open Source, Govt. Ownership, No licenses, subscriptions, interoperable, etc.)
Start with Solutions That Meet Criteria (don’t spend time cataloging existing programs set target instead)
Recognize Market Trends (smartphone cost going down)
Start Transition from hard copy to digital for everything
Enable library that anyone can contribute to or draw from (NGOs, iNGOs still retain mandate for training)
Provide private sector access in return for investment ( need to fund foundational layer in training and technology)
Technological Solutions can drive policy (make legislators aware of state of technology)

26. Open Deliver: Digital Content Delivery System
Incentivizes the contribution of validated content to content sharing platform (like ORB) by providing immediate means of distribution
Reduces duplication through Collaborative content production
Separates content from technology allowing technology to scale independent of evidence of content effectiveness
Reduces the time and cost to implement solutions for specific contexts and geographies by standardizing production process
Establishes an open collaborative model for the ongoing refinement of the process that can evolve independent of specific technologies
Contextualizes the evaluation of mHealth by providing a centralized resource of national content with a standard delivery system and large sample size
We can also incentivize by (1) encouraging organizations who may still be reluctant to share their content to share selected content as a way of ‘showcasing’ the quality of their work. This opens the door to conversations for increased sharing of content; (2) using advocacy based on the Principles for Digital Development – reaching out to organizations which have endorsed these to invite them to share content

27. Thank you!